Sunday, August 23, 2009

Pro tennis player Simona Halep's cups no longer runneth over.

While we're on a run of breast reduction posts, I'd like to highlight the related story of Romanian tennis player, Simona Halep. Ms. Halep is a 17 year old tennis prospect who was good enough to win the French Open junior division in 2008 and is working her way up the WTA rankings (currently at #274). Unfortunately for her, she was attracting as much attention for her breast size (reportedly 34DD) as she was for her tennis talent.

Well word got out in the spring that she was considering a breast reduction (reduction mammaplasty), it took things to a whole other level. Photo spreads in British tabloids, fan sites, "Stop Simona from reducing her breasts" Facebook groups (I'm not kidding, click here), and even the infamous Opie & Andy show on satellite radio got in on the act.

Here's a video clip of her practicing where you can see the problems large breasts would cause with movement. WOW, Does she really hit the ball hard or what!

Well it would appear Simona quietly went ahead with the surgery this summer and is recovering to return to her high level athletic career. Resuming the training and competing after this operation could be tricky. There's real reason to be extremely conservative in clearing her to train. At 2 weeks after surgery the breaking strength of her scar would be about 50%, and by six weeks it would be approaching 90% tensile strength. With the kind of torque, tension, and range of motion she will be putting on her incisions there is real reason to believe she may have issues with poor scarring from her reduction.

Discussing her decision in interviews, Ms. Halep
But Simona's set proved too much to handle during matches and she feared they were stopping her from winning titles.

Last month she admitted: "It's the weight that troubles me - my ability to react quickly, my breasts make me uncomfortable when I play as well.

"I don't like them in my everyday life either. I would have gone for surgery too, even if I hadn't been a sportswoman," she added.

The photo below is purportedly after her surgery in late June or early July.

A breast reduction the size of hers is likely not going to be possible with many of the modern "short scar" techniques that I prefer. I would bet she had a traditional "Wise Pattern" or anchor shaped incision.


Monday, August 17, 2009

Breast reduction surgery and quality of life - Addition by Subtraction!

Breast reduction surgery presents an interesting issue when we're getting into an era where every health care cost is going to be scrutinized. As a society, is this a procedure we're going to be willing to commit major funding to? Currently there is a patchwork of indications that vary between different insurance companies as to what meets medical necessity for this operation.

In general, most insurers make you do extensive documentation of "conservative therapy" before even considering approval. I'm not sure what conservative management of big breast is exactly anyway! There are differing weight requirements for the tissue to be removed as well. Blue Cross of Alabama for instance requires a minimum of 500 grams (~1.1 lbs) per breast to be removed. Others use a sliding scale called the "Schnur Scale" to correlate appropriate weight removal to a calculation of your total body surface area (TBSA). The Schnur scale came from a paper by a plastic surgeon who was trying to quantify symptoms in his breast reduction patients.

The recommendations from that study by Dr. Schnur were perverted by insurers, written into policy guidelines, and are now used to exclude many patients from having breast reduction surgery. There now exists a great deal of literature showing that reductions much less then prescribed by insurance companies is effective in patients suffering from neck, back, and shoulder pain. In fact, a Finnish study suggests breast reduction surgery seems to improve the health-related quality of life indicators as much or more then surgeries for hip or knee joint replacement.These studies are dismissed by insurers as observational,flawed, or biased by greedy doctors, but if they could speak honestly they would explain that they don't want to open eligibility for the procedure to a whole new class of patients and cost themselves a great deal of money.

Apparently we're not the only country that is having issues on whether to cover breast reduction surgery. Hat tip!
A court in the German state of Hessen has ruled that insurance companies do not need to cover the cost of breast reduction surgery as having a large bust is not a medical problem. The decision means that insurers will only have to pay to correct breasts which are deformed.

The case was brought by a 38-year-old woman who suffered orthopaedic and physical problems due to the weight of her boobs. She had been advised by doctors to have breast reduction surgery.

But her insurance company didn’t see it as a necessity and therefore refused to cover the costs of the operation. It claimed she was suffering from back problems because she was overweight and that her physical discomforts would be reduced if she trimmed down weight and built some muscle up.

The court agreed with the insurance company and the big-breasted woman lost her case.

Two and a half years ago, the court in Hessen rejected the case of a woman who thought her breasts were too small. She wanted her medical insurance to cover a breast enlargement operation and claimed that she was physically harassed for her small boobs. The court declared then that small breasts are not an illness


Tuesday, August 11, 2009

The World's Worst Plastic Surgery Logos

Choosing your business logo is important, and that holds true for plastic surgery practices as well. When we worked on ours, it took literally dozens of ideas and revisions to get where we wanted. It turned out pretty well if you consider the fact that our trademarked logo for Plastic Surgery Specialists has been "borrowed" by at least half a dozen web sites I've found.

Quick plagiarism trivia: If you'll remember, Richard Ashcroft, lead singer of British pop band The Verve was found guilty of plagiarizing the melody from the Andrew Oldham Orchestra recording of The Rolling Stones' 1965 song "The Last Time" for their 1997 #1 hit "Bittersweet Symphony". Ashcroft was forced to relinquish millions of dollars in songwriting royalties to Mick Jagger & Keith Richards.

Anyway, in doing research for our logo last year, Dr. Jason Jack and myself looked at hundreds of other practices logo choices. There were a few that stood out as really bad.

1. We thought this looked like the "Mud Flap trucker girl".


2. This one reminded me of all those bad 1970's brown color schemes

Compare it to this 1970's fabric courtesy of the "Tune Up" blog devoted to vintage fabric (talk about your narrow reader demographic!)

It also kind of reminds me of the 1970's San Diego Padres Uniforms.

3. This logo has four different type fonts fighting for supremacy

4. This logo was just too "subtle" :)

Did someone really think a Pitcher Plant emerging from some one's vagina was the right way to go with this ad? Obviously this campaign did not get wife approval factor (WAF) before going to print.

5. I call this ugly logo of various body parts the "Homunculus". A homunculus is any representation of a human being, and is often used to illustrate the functioning of a system.

In medical school neuroanatomy, the concept of this is used to show what areas of the brain control the body.

Not related to plastic surgery per se, but this pediatric clinic logo really could use a redesign :)

FYI, there's a great blog post on the world's worst logo here.

Sunday, August 09, 2009

20/20 segment on the tradeoff's in healthcare reform

Good story on some of what you have to give up to expand healthcare coverage. It's not all win-win when you disincentive 20% of the economy.

Hat tip to my partner, Dr. Jason Jack BTW!